Has Anything Changed in the Frequency of Emergency Department Visits and the Profile of the Adolescent Seeking Emergency Mental Care during the COVID-19 Pandemic?

We described changes caused by the COVID-19 pandemic in the frequency of Emergency Department (ED) visits for mental health disorders (MHDs) in adolescents on a wider temporal range-that is, not just "the waves" of the pandemic-and characterized the profile of the adolescent seeking emergency psychiatric care. We conducted a retrospective longitudinal study by analyzing ED visits for MHDs from 10 March 2019 to 10 March 2021. A total of 1407 ED visits for MHDs were registered: 702 in the pre-COVID-19 and 707 in the COVID-19 period. The cumulative incidence of ED visits for MHDs was 1.22% in the pre-COVID-19 period and 1.77% in the COVID-19 period, with a statistically significant difference (p < 0.001). The principal characteristics of the adolescent with MHDs during the pandemic period: the odds of comorbidities decreased by 26% (p = 0.02), and the odds of transfer from other hospitals decreased by 71% (p < 0.001), while the odds of the ED presentation as first psychiatric episode were twice greater (p < 0.001). The risk of hospitalization increased by 54% (p = 0.001). Regarding psychopathology, the likelihood of attempted suicide increased by 74% during the pandemic (p = 0.02). The rate of mood and eating disorders grew significantly during the COVID-19 pandemic period (p = 0.005 and p = 0.031, respectively). Monitoring ED visits for MHDs and understanding changes in the profile of adolescents presenting to ED helps to reinforce the role of ED in identifying special clinical needs for these vulnerable patients in case of a future public health crisis.

Neurodevelopmental Trajectories and Clinical Profiles in a Sample of Children and Adolescents With Early- and Very-Early-Onset Schizophrenia.

Schizophrenia before the age of 18 years is usually divided into two categories. Early-onset schizophrenia (EOS) presents between the ages of 13 and 17 years, whereas very-early-onset schizophrenia (VEOS) presents at or before the age of 12 years. Previous studies have found that neurodevelopmental difficulties in social, motor, and linguistic domains are commonly observed in VEOS/EOS patients. Recent research has also shown a high prevalence of neurodevelopmental disorders (e.g., intellectual disability, communication disorders, autism spectrum disorder, neurodevelopmental motor disorders) in VEOS/EOS patients, indicating genetic overlap between these conditions. These findings lend support to the neurodevelopmental continuum model, which holds that childhood neurodevelopmental disorders and difficulties and psychiatric disorders (e.g., schizophrenia) fall on an etiological and neurodevelopmental continuum, and should not be considered discrete entities. Based on this literature, in this study we focused on the overlap between neurodevelopmental disorders and schizophrenia investigating, in a large sample (N = 230) of VEOS/EOS children and adolescents, the clinical differences, at the onset of psychosis, between VEOS/EOS with neurodevelopmental disorder or neurodevelopmental difficulties and VEOS/EOS with no diagnosed neurodevelopmental disorder or neurodevelopmental difficulties. The findings showed that, in children and adolescents with a neurodevelopmental disorder or neurodevelopmental difficulties, psychosis onset occurred at an earlier age, was associated with more severe functional impairment (e.g., global, social, role), and was characterized by positive symptoms (e.g., grandiose ideas, perceptual abnormalities, disorganized communication) and disorganized symptoms (e.g., odd behavior or appearance, bizarre thinking). Instead, in children and adolescents without a neurodevelopmental disorder or neurodevelopmental difficulties, psychosis onset was mainly characterized by negative symptomatology (e.g., social anhedonia, avolition, expression of emotion, experience of emotions and self, ideational richness). Given these differences, the presence of a neurodevelopmental disorder or neurodevelopmental difficulties should be carefully investigated and integrated early into the assessment and treatment plan for VEOS/EOS patients.

Clinical significance of family accommodation and parental psychological distress in a sample of children and adolescents with obsessive-compulsive disorder aged 8-17 years old.

BACKGROUND: Family Accommodation (FA) refers to the involvement of family members (especially parents) in the compulsive behaviors of children and adolescents with Obsessive-Compulsive Disorder (e.g. modifying family routines or facilitating avoidance of obsessive-compulsive triggers). Many studies have examined the high prevalence of FA in this clinical population; however, less is known about its clinical significance and relationship to the individual psychological distress of parents. In our study, we investigated the clinical significance of FA examining its relationship with obsessive-compulsive symptomatology, functioning, anxiety and depressive symptoms in a clinical sample (n = 51) of children and adolescents with Obsessive-Compulsive Disorder (OCD) aged 8-17 years old and their parents, included to examine their individual psychological distress. METHODS: The sample was divided into two groups: the High Accommodation group (n = 36) and the Low Accommodation group (n = 15). RESULTS: Results demonstrated that children and adolescents in the OCD High Accommodation group reported major functional impairment in global (p = .001313), social (p = .000334) and role (p = .000334) domains, and higher depressive symptoms than the Low Accommodation group. Both fathers and mothers from the High Accommodation group reported a higher level of individual psychological distress compared to mothers and fathers from the Low Accommodation group (p = .040365). CONCLUSIONS: The findings of this study show that FA is common in children and adolescents with OCD and it could cause not only an impairment of the patient's global, social and role functioning but also a high level of individual psychological distress in the single parent. The presence of FA should therefore be carefully investigated and considered in planning assessment and treatment of OCD in children and adolescents.

Peer Victimization and Onset of Social Anxiety Disorder in Children and Adolescents.

BACKGROUND: In the literature, several studies have proposed that children and adolescents with social anxiety had experienced previously victimization from peers and siblings. The aim of this review was to contribute to the updating of recent findings about the relationship between peer victimization and onset of social anxiety in children and adolescents. METHODS: A selective review of literature published between 2011 and 2018 on Social Anxiety Disorder in children and adolescents that experienced peer victimization during childhood and adolescence. RESULTS: Seventeen studies are included. All studies showed that peer victimization is positively correlated to the presence of social anxiety. Moreover, the perpetration of peer victimization may contribute to the maintenance and the exacerbation of social anxiety symptoms. CONCLUSIONS: In children and adolescents with Social Anxiety Disorder, it is necessary to evaluate firstly the presence of peer victimization experiences. Subsequently, therapeutics programs targeted to elaborate these experiences and to reduce the anticipatory anxiety and the avoidance that characterized these children and adolescents can be proposed.

Prevalence and Clinical Significance of Symptoms at Ultra High Risk for Psychosis in Children and Adolescents with Obsessive⁻Compulsive Disorder: Is There an Association with Global, Role, and Social Functioning?

In literature nothing is known about the clinical significance of Ultra High Risk (UHR) symptoms in children and adolescents with diagnosis of obsessive⁻compulsive disorder (OCD). In this study, we examined the prevalence of UHR symptoms and their relationship with severity of obsessive⁻compulsive symptomatology, global, social, and role functioning, and level of associated depressive symptoms in a clinical sample (n = 51) of children and adolescents aged between 8 and 17 years with a diagnosis of OCD. The prevalence of UHR symptoms in this sample was 43.1%. We divided the whole sample into two groups: children and adolescents with OCD and UHR symptoms (n = 22) and children and adolescents with OCD without UHR symptoms (n = 29). Our findings suggest that the group with OCD and UHR symptoms shows worse global, social, and role functioning than the group with OCD without UHR symptoms. No differences were found on the severity of obsessive⁻compulsive symptomatology, the number of psychiatric diagnoses associated, and the level of depressive symptoms. The presence of UHR symptoms in children and adolescents with OCD could cause significant functional impairment and should be considered in order to plan specific and targeted therapeutic interventions.

All that glitters is not gold: prevalence and relevance of psychotic-like experiences in clinical sample of children and adolescents aged 8-17 years old.

AIM: Recent studies have examined the prevalence of psychotic-like experiences (PLEs) and their relationship with functioning, psychopathology and distress in adult and mixed young adult and adolescent samples. There is, however, a lack of knowledge about the prevalence and clinical weight of PLEs in clinical child and adolescent (CAD) populations. Available research has primarily been conducted on community populations, and even clinical samples mostly used self-reported questionnaires. These studies also recruited participants 12 years old and older, with a consequent lack of information on children from 8 to 11 years old. We examined the prevalence of PLEs and their relationship with psychiatric diagnosis, functioning, intelligence quotient (IQ), anxiety and depressive symptoms in a clinical sample aged 8-17 years old. METHODS: The study was conducted on a clinical sample of 46 CAD with PLEs compared to a clinical sample of 60 CAD without PLEs. The two groups were compared on global, social and role functioning, IQ, anxiety and depressive symptoms, and number of psychiatric diagnoses. RESULTS: Global, role and social functioning were significantly lower in the CAD clinical sample with PLEs. These significant differences were maintained when the covariate IQ, number of psychiatric diagnoses or level of anxiety or depression was added. No significant age-related differences in the presence of PLEs were found. CONCLUSION: The findings of this study show that PLEs are common in a clinical sample of CAD, even those under 12 years old. The presence of PLEs should therefore be investigated and considered in planning treatment of non-psychotic psychiatric disorders in CAD.

Cognitive behavioural therapy for auditory hallucinations in schizophrenia: A review.

AIM: To provide an updated of recent findings about efficacy of cognitive-behavior therapy (CBT) in reduction of command hallucinations. METHODS: PubMed/MEDLINE, Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO, ClinicalTrial.gov searches were performed using the keywords "hallucinations", "behavioural therapy" and " cognitive therapy" in order to identify relevant articles published during the years of 2011 to 2016. No language limits were used. Studies conducted within control group, reviews, editorials, were excluded. Data on efficacy, acceptability and tolerability were extracted by three authors independently. Disagreements were resolved in a consensus meeting or by another reviewer. RESULTS: A total of eight articles were eligible for inclusion. Two are randomized clinical trials (RCTs) and six are observational studies. The two RCTs included showed a greater efficacy of CBT compared to standard care on auditory hallucinations (AHs). Nevertheless, they considered different CBT models, particularly Treatment of Resistant Command Hallucinations and Cognitive Therapy for Command Hallucinations. As regards non RCT-studies, all papers included showed reduction on frequency and severity of AHs and distress related to them. However, the lack of content details within non-RCTs studies decreased their comparability. In terms of predictive variables, our findings show that negative symptoms at baseline appeared to be the strongest predictor of the treatment efficacy. Indeed, negative symptoms showed a significant negative correlation on outcome. CONCLUSION: Although more conclusive studies are still needed, we found some preliminary evidence for the efficacy of CBT in the treatment of command hallucinations.

Twelve-month psychosis-predictive value of the ultra-high risk criteria in children and adolescents.

OBJECTIVE: The validity of current ultra-high risk (UHR) criteria is under-examined in help-seeking minors, particularly, in children below the age of 12 years. Thus, the present study investigated predictors of one-year outcome in children and adolescents (CAD) with UHR status. METHOD: Thirty-five children and adolescents (age 9-17 years) meeting UHR criteria according to the Structured Interview for Psychosis-Risk Syndromes were followed-up for 12 months. Regression analyses were employed to detect baseline predictors of conversion to psychosis and of outcome of non-converters (remission and persistence of UHR versus conversion). RESULTS: At one-year follow-up, 20% of patients had developed schizophrenia, 25.7% had remitted from their UHR status that, consequently, had persisted in 54.3%. No patient had fully remitted from mental disorders, even if UHR status was not maintained. Conversion was best predicted by any transient psychotic symptom and a disorganized communication score. No prediction model for outcome beyond conversion was identified. CONCLUSIONS: Our findings provide the first evidence for the predictive utility of UHR criteria in CAD in terms of brief intermittent psychotic symptoms (BIPS) when accompanied by signs of cognitive impairment, i.e. disorganized communication. However, because attenuated psychotic symptoms (APS) related to thought content and perception were indicative of non-conversion at 1-year follow-up, their use in early detection of psychosis in CAD needs further study. Overall, the need for more in-depth studies into developmental peculiarities in the early detection and treatment of psychoses with an onset of illness in childhood and early adolescence was further highlighted.

Borderline cognitive level in a family with Bazex-Dupré-Christol syndrome.

Bazex-Dupré-Christol syndrome (BDCS) [OMIM 301845] is an X-linked dominant disorder of the hair follicle characterized by multiple basal cell carcinomas, follicular atrophoderma, congenital hypotrichosis, and hypohidrosis. Additional features include multiple milia, trichoepitheliomas, and axillary hidradenitis suppurativa as well as a variety of other symptoms. Some patients with a diagnosis of BDCS have had poor school performance. But no other associated psychopathological disorders have been described in the literature. We describe the neuropsychological characteristics and the co-occurring psychopathological disorders in an Italian family (brother and sister, and their mother) affected by BDCS. The BDCS phenotype in this family was characterized by hypotrichosis, atrophoderma follicularis, milia, and trichoepitheliomas. No basal cell carcinomas were documented. At neuropsychological assessment the three affected family members all had a borderline cognitive level. Other identified psychopathological disorders included attention deficit hyperactivity disorder, executive deficits, academic difficulties, deficits in lexical skills, and internalizing problems. The presence of cognitive impairment in the three family members affected by BDCS suggests that cognitive impairment may be associated with the syndrome. It may be useful to assess neuropsychological performance in patients with BDCS to identify possible associated neuropsychological disorders.